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Neuro Seizures: Intracranial Pressure: when increased: -partial seizures: -altered LOC simple: focal, subjective experience -normal ICP: 0-15...

Neuro Seizures: Intracranial Pressure: when increased: -partial seizures: -altered LOC simple: focal, subjective experience -normal ICP: 0-15 complex: effects temporal lobe, loss of consciousness -s/s: cushings triad -limp, dazed, confused, lip smacking, drooling, etc. irregular RR -generalized seizures: BP (wide map) absence: brief loss of consciousness, no recall HR myoclonic: no loss of consciousness, no postictal phase, -other s/s: weakness, lethargy, headache, vomiting, vision brief contracture changes, behavioral changes tonic-colonic: loss of consciousness, incontinence, postictal -treat: phase lasts hours, tonic: rigid clonic: jerking IV mannitol atonic: a kinetic, head drop to fall hyperventilation -management: elevate head diagnose: CT, MRI, blood work, EEG drain extra fluid treat: antiepileptics, anticonvulsants craniotomy surgery: DBS, vagaries nerve stimulator Diagnostics: -complications: -PET status epilepticus: seizure activity 5 mins+ or 2+ seizures -cerebral angiography: xray w/ arterial contrast without recovery -electroencephalography -ABCs -lumbar puncture -ativan or versed (benzos), keppra or dilantin Glasgow Coma Scale: -last resort: propofol or phenobarbital coma Cephalalgia (Heeadache): -primary headache: no underlying cause tension (muscular), migraine (vascular), cluster (neuro) -secondary headache: underlying cause sinuses, ear, nose, mouth, referred pain, cervicogenic -management of primary HA: HA diary, blood test, CFS, imaging -treat: NSAIDs, underlying cause, triptans, anti-depressants Meningitis: -inflammation of meninges Alzheimer s: viral, fungal, bacterial -unknown cause -risk factors: -diagnosis made at autopsy viral: mumps, measles, herpes, west nile -assessment: fungal: sinus infection from certain fungus 1st: forgetfulness bacterial: otitis media, sinusitis difficulty with language -assessment: agnosia: difficulty processing sensory information opisthotonos: HTN of head w/ arching of back -common meds: aricept, exelon, razadyne, namenda headaches, altered mental status Seizures: phonophobia, dislikes bright lights -uncontrolled electrical discharges of neurons leading to N/V, pale skin, rash altered LOC systemic: high fever, seizures, stiff neck, difficulty walking -epilepsy: chronic recurring abnormal brain activity -diagnosis: -risk factors: spinal fluid collected, kernig s, brudzinski s fever, infection -treatment: hypogylcemia, hyponetremia broad spectrum antibiotics head trauma, brain tumor, stroke, hypoxia substance withdrawal, toxin exposure cessation of antiepileptic meds Encephalitis: Myasthenia Gravis: -acute inflammation of the brain (usually viral) -acquired autoimmune disorder -encephalomyelitis: when the inflammation includes the -muscle weakness that fluctuates brain and spinal cord -mild: ptosis (drooping eyelids), diplopia (double vision) -causes: HSV, enterovirus, rabies, tick borne viruses -severe: generalized weakness and respiratory involved -assessment: -assessment: symptoms of infection (fever) bulbar s/s: difficult phonation, chewing, swallowing neuro deficits ( LOC) CN IX, X, XI, XII -brain abscess (s/s): -management: frontal: aphasia, headache, seizures, hemiparesis (weak labs: serological testing (AChR antibodies) on one side of the body) receptive nerve stimulation ( muscle response) temporal: vision changes, facial weakness, headache, electromyography: needles put in muscle to measure receptive aphasia electrical activity cerebellar: ataxia (poor coordinat), nystagmus, headache tensilon test: give edrophonium IVP look for muscle tone -management: antivirals -atropine at bedside for reversal acyclovir, gancivlovir CT scan: thymoma -nursing considerations: -meds: watch for ICP pyridostigmine, neostigmine, immunotherapy watch for nuchal rigidity contradicted: CCBs, mag Brudzinski and Kernig sign Myasthenia Crisis vs Cholinergic Crisis: vitals ( HR, temp) -myasthenia crisis: exacerbation causing respiratory failure CN III, IV, VI (eye on one side will deviate; abnorm. pupil) caused by respiratory infection I&O treat: immunoglobulin or plasmapharesis -labs: -cholinergic crisis: due to excessive anticholinesterase meds CBC (antivirals effect blood count) -tensilon test to determine which it is LFT s (antivirals can cause hepatotoxicity) if pt shows muscle strength improvement: MS -nursing interventions: if pt shows fasciculations and muscle weakness: Choliner. HOB 30-45 degrees -assess: resp status, nutritional stat, dysarthria, dysphagia seizure precautions -interventions: encourage oral intake give meds before eating dim lights, calm environment elevate HOB turn q2 hr establish effective communication method stool softeners plan meals when meds are peaking; plan rest periods Multiple Sclerosis: Guillain-Barre Syndrome (BGS): -chronic, progressive, irreversible autoimmune disorder -acute inflammatory demyelinating polyneuropathy -unknown cause -occurs after an infection (GI/resp) leads to rapid paralysis -immune attack destroys myelin sheath, leading to campylobacter jejuni, cytomegalovirus, epstein-barr, demyelination, interrupting conduction mycoplasma pneumonia, hemophilius influenzae -risk factors: -3 stages: genetics, female 20-50 acute (4 weeks) -assessment: plateau (few days to weeks) radiologically isolated syndrome (RIS) recovery clinically isolated syndrome (CIS) -assessment: symmetrical ascending motor weakness and -unilateral optic neuritis, focal s/s, partial myelopathy paralysis (from toes up) -pain, fatigue, tremors areflexia key finding -ataxia, bladder dysfunction, depression, spasticity -diagnosis: s/s, CSF has increased protein and normal cells -diagnostics: -treat: IV Ig, plasmapheresis-watch for septicemia labs: CSF analysis (protein and WBCs), CSF electrophoresis -assess: CN s, respiratory stat, motor and sensory, pain (increased T lymphocytes), increased immunoglobulin -interventions: reposition q2h, pain relief, VTE prevention procedures: MRI-plaques, evoked potential visual test Trigeminal Neuralgia: -interventions: no cure -pain disorder effecting whole face; risk factors: HTN, MS provide support and structure -assessment: sharp, shocking pain during ADLs w/ face goal: delay progression, manage chronic s/s, treat acute -manage: carbamazepine, oxcarbazepine, gabapentin, exacerbations baclofen, tegretol to risk of seizures Bells palsy: Huntington s Disease: -idiopathic facial paralysis; facial nerve involvement -chronic progressive disease of nervous system resulting in -causes: reactivation of herpes vesicles in and around the involuntary choreiform movement and dementia ear will proceed facial paralysis -assessment: -treat: corticosteroids, antivirals triad of s/s: -full recovery in 6 months in most pts -motor dysfunction: chorea, rapid jerky movements Brain Tumors: -cognitive impairment -space occupying lesions; ICP -behavioral features: apathy and blunted affect -slow growing; can be benign or malignant and aggressive -treat: optimize QOL, no cure -WHO classification: s/s management of chorea with tetrabenazine grade (I-IV) rate of growth cell behavior Muscular Dystrophy: Gliomas: -progressive muscle degeneration and weakness -cerebrum; grade I&II are slow growing -most common: duchenne and becker forms -anaplastic glioma: grade III -cause: genetic mutation leads to muscle atrophy -glioblastoma: grade IV; very aggressive and lethal Meningioma: -most common in females; in meninges; 90% benign Oligodendrogliomas: -cerebrum; slow growing; doesn t spread Acoustic Neuromas (Schwannomas): -originate from nerve protective coverings -slow growing; benign and don t spread -pituitary tumors: most common-adenoma (benign) -assessment: depends on location result from ICP -ha, changes in LOC, seizures, N/V -pupillary and vision changes - BP HR -cranial nerve palsies -management: surgery, chemo, radiation -complications: post op bleeding ICP, cerebral edema -diuretics, hyperventilation, elevate HOB, glucocorticoids seizures, VTE Parkinson s Disease (PD): -a progressive neurodegenerative disease of CNS -motor dysfunction -idiopathic, loss of dopamine-producing brain cells -diagnosis: made by progressive decline in motor function with tremors and rigidity -4 cardinal signs: resting tremors muscle rigidity bradykinesia/akinesia (loss of movement) postural instability (knees and hips bent) -management: cogentin, artane, mirapax, requip, sinemet -surgery: stereotactic pallidotomy -nursing conciderations: check gag/swallow; incontinence